Knee & Joint Pain

Contributed by Dr. Steven T. Devor – Director of Performance Physiology for MIT and OhioHealth, and Associate Professor of Exercise Physiology, Department of Human Sciences, and Department of Physiology and Cell Biology, The Ohio State University

Over the years I have been asked a lot of questions about how to best protect knees and other joints with running and walking.  Because of the compressive forces and types of muscle contractions involved, running and walking can be hard on your body, especially if you have a larger frame.  My hope is you will plan on running and walking long term to enhance your overall health, wellness, and fitness.  Through the years I have come up with 10 general tips that will help keep you on the move.

1. Take at least one or perhaps two rest days per week   Ideally, this means no impact in order to give your joints a rest from the pounding forces that running and walking produces. Less experienced runners or walkers may need two or three rest days per week.  Remember that you adapt after a workout, and your body will adapt best if you provide proper rest.  If you try to circumvent this process, an overuse injury becomes much more likely.  S/he who recovers first wins.

2. Perform no more than one or two "key" or high-intensity interval workouts per week   Speed work puts more stress and the body, and requires more recovery time. These types of training sessions must be performed prescriptively and carefully. Try to schedule your speed work or interval workouts the day prior to a rest or recovery day and after an easy run day, and this approach will give you the best adaptation (see tip number 1). If this is your first half or full marathon, file this information away for the future, but remember, speed work comes later!

3. Train in two- to three-day cycles, with a rest or recovery workout in between cycles   This allows your body to adapt to the stress of training.  Some runners will need more rest and less training, especially as intensity increases.  A rest or recovery workout is best scheduled after an increase in weekly mileage.

4. Change your running shoes frequently and only use them for running   A good rule of thumb is to change shoes every 350 to 400 miles.  You may want to write the date you purchased your shoes in permanent ink on your shoes for reference.  Buying new running shoes is not inexpensive, but your insurance deductible for an overuse injury office visit with your physician is likely more.  Remember to only use your running shoes for your run training.  The midsoles will break down much more rapidly if you are wearing them to other aerobics or strength training classes in your gym, or using them to wear around the house and yard.

5. Consider taking the supplements Chrondroitin Sulfate and Glucosamine   I do not recommend a lot of supplements, but this combination has shown promise in clinical studies and in control groups of people suffering from knee pain. One works as an anti-inflammatory (Chrondroitin); the other helps regenerate cartilage (Glucosamine).  I know several orthopedic surgeons who are recommending the supplement to their patients.  I believe it is worth a try if you are having knee pain and have discussed it with your physician.

6. Increase your volume of endurance training by less than 10 percent per week   This one is important to avoid many overuse injuries.  Increasing your mileage too quickly is a quick route to promote injury.  Your body adapts to stress (i.e., training) and builds, or gets stronger.  If you put too much stress on your body, it can not properly adapt and will break down further instead of getting stronger.

7. Listen to your body   In my experience, your body typically gives you an indication that you are about to sustain an overuse injury.  This may be in the form of a slight or nagging pain. Stop training, or slow down significantly, and you will more than likely be all right after a bit of rest.  If you try to push through the pain, you may end up with a more serious injury. If you are exceptionally tired during a run and your legs feel heavy or flat, take a day off.

8. Periodize your training   Periodization of training refers to training in specific cycles that move you towards a goal (e.g., a race).  Your run training moves from the general to the specific, and from low intensity to higher intensity as you approach your peak. This means performing your most intense work late in the season near your goal race or peak.  Trying to perform intense run workouts year round will ultimately degrade your performance and likely lead to an overuse injury.  All elite endurance athletes train in a periodization manner as they prepare for certain key races. 

9. Use resistance training exercises to keep your knees strong and stable, prevent muscle imbalances and improve performance   One of the more common overuse injuries is “runner's knee”.  This injury can be the result of a patella (a.k.a. knee cap) tracking problem, much like a tire that is out of alignment.  Maintaining strong quadriceps can help you prevent this condition.  If you are an endurance runner you do not need to overwork, or greatly fatigue, these muscles or use a lot of weight, but light strength work performed correctly can without question help prevent injury.

10. Cross train   One of the benefits that multi-sport athletes have over runners is that they are able to perform swim and cycling workouts in between run workouts.  These different sport workouts help reduce the stress caused by the pounding of running, but the athlete still receives the aerobic benefit of training. Cross training is good for active recovery which helps speed the recovery process. If you use a heart rate monitor you can stay in the same heart rate zone as your run workout. Swimming, cycling, using the stepper, elliptical trainer, or even hiking are all good examples of cross-training workouts.

Best wishes for continued success with your training.

Dr. Devor

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